Stereotactic radiosurgery as single-modality treatment of incidentally identified renal cell carcinoma brain metastases

Marko, Nicholas F.; Angelov, Lilyana; Toms, Steven A.; Suh, John H.; Chao, Sam T.; Vogelbaum, Michael A.; Barnett, Gene H.; Weil, Robert J.

doi:10.1016/j.surneu.2009.02.011

« Previous Next »World Neurosurgery
Volume 73, Issue 3 , Pages 186-193, March 2010

Stereotactic radiosurgery as single-modality treatment of incidentally identified renal cell carcinoma brain metastases☆

Nicholas F. Marko, MD
- Department of Neurosurgery, The Cleveland Clinic, Cleveland, OH 44195, USA
- Corresponding author. Department of Neurosurgery, Cleveland Clinic, Desk S-80, Cleveland, OH 44195, USA. Tel.: +1 216 444 5539; fax: +1 216 636 0454.
Lilyana Angelov, MD
- Department of Neurosurgery, The Cleveland Clinic, Cleveland, OH 44195, USA
- Department of Brain Tumor and Neuro-Oncology Center, Neurological Institute, The Cleveland Clinic, Cleveland, OH 44195, USA
- Reprint requests and other correspondence may be addressed to either LA or RJW: Lilyana Angelov, MD, Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195. Robert J. Weil, MD, Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195.
Steven A. Toms, MD, MPH
- Department of Neurosurgery, Geisinger Medical Center, Danville, PA, USA
John H. Suh, MD
- Department of Brain Tumor and Neuro-Oncology Center, Neurological Institute, The Cleveland Clinic, Cleveland, OH 44195, USA
- Department of Radiation Oncology, Taussig Cancer Center, The Cleveland Clinic, Cleveland, OH 44195, USA
Sam T. Chao, MD
- Department of Brain Tumor and Neuro-Oncology Center, Neurological Institute, The Cleveland Clinic, Cleveland, OH 44195, USA
- Department of Radiation Oncology, Taussig Cancer Center, The Cleveland Clinic, Cleveland, OH 44195, USA
Michael A. Vogelbaum, MD, PhD
- Department of Neurosurgery, The Cleveland Clinic, Cleveland, OH 44195, USA
- Department of Brain Tumor and Neuro-Oncology Center, Neurological Institute, The Cleveland Clinic, Cleveland, OH 44195, USA
Gene H. Barnett, MD
- Department of Neurosurgery, The Cleveland Clinic, Cleveland, OH 44195, USA
- Department of Brain Tumor and Neuro-Oncology Center, Neurological Institute, The Cleveland Clinic, Cleveland, OH 44195, USA
Robert J. Weil, MD
- Department of Neurosurgery, The Cleveland Clinic, Cleveland, OH 44195, USA
- Department of Brain Tumor and Neuro-Oncology Center, Neurological Institute, The Cleveland Clinic, Cleveland, OH 44195, USA
- Reprint requests and other correspondence may be addressed to either LA or RJW: Lilyana Angelov, MD, Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195. Robert J. Weil, MD, Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195.

Received 9 June 2008; accepted 19 February 2009. published online 16 July 2009.

Abstract

Background

Initial staging evaluation of patients with renal cell carcinoma (RCC) has led increasingly to the diagnosis of brain metastases in patients who are otherwise neurologically asymptomatic. We present our experience treating patients with incidentally identified brain metastases with initial stereotactic radiosurgery (SRS) monotherapy and compare outcomes with those of patients treated at our institution with other strategies and with those reported in the literature.

Methods

We conducted a retrospective outcomes analysis in patients with incidentally identified RCC brain metastasis treated with initial SRS monotherapy. Our radiation oncology and tumor databases were reviewed, identifying 80 patients treated between 1990 and 2006.

Results

We found 19 patients with asymptomatic, incidentally identified brain metastasis (KPS, 90-100) treated with SRS monotherapy within 60 days of diagnosis. Stereotactic radiosurgery was performed at a mean of 17.8 days from diagnosis to an average of 3.1 lesions (range, 3-11; mean lesion volume, 1.72 cm³; mean total volume, 4.53 cm³). The mean prescription was 21.3 Gy delivered to the mean 59.97% isodose line. The mean survival for these patients was 21.5 months (median, 12.6 months) and was not statistically different from survival in similar patients treated with other therapeutic modalities. Local control was achieved in 95% of patients; distant central nervous system progression occurred in 79% of patients at a mean of 450 days.

Conclusions

We demonstrate that patients with incidentally identified RCC brain metastases treated with initial SRS monotherapy achieved a survival rate comparable with that of patients managed with standard therapeutic modalities. Our findings suggest that SRS alone is an attractive therapeutic option for patients with incidentally identified brain metastases from RCC.

Abbreviations: cGy, centigray, CNS, central nervous system, ECOG, Eastern Cooperative Oncology Group, KPS, Karnofsky Performance Score, RCC, renal cell carcinoma, RPA, recursive partitioning analysis, RTOG, Radiation Therapy Oncology Group, SRS, stereotactic radiosurgery, WBI, whole brain irradiation, WBRT, whole brain radiotherapy

Keywords: Renal cell carcinoma, Stereotactic radiosurgery, Radiation, Survival, Performance score, Recursive partitioning analysis

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☆ Authorization of copyright transfer: The authors hereby authorize transfer of copyright for this manuscript to the editorial board of the publishing journal at the time of print and/or electronic publication.

PII: S0090-3019(09)00223-7

doi:10.1016/j.surneu.2009.02.011

« Previous Next »World Neurosurgery
Volume 73, Issue 3 , Pages 186-193, March 2010

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